We have decided to write an article about the movie “Still Alice” from the autobiographical novel “The Butterfly’s Flight” written by Lisa Genova. This movie is about the story of Alice Howland, a talented and passionated Harvard teacher, who developed early Alzheimer’s disease (AD) at the age of 50. The author shows us the degeneration caused by AD from the heroin viewpoint.
Alice lives the life she has always dreamed of: an exciting job in which she is known and recognized. On the family level, her marriage is fulfilling and her children follows their path.
However, several events, such as a lack of word, a loss of memory about the course she had to teach and spatial disorientation while she was jogging led Alice to worry about the presence of a possible tumor. It is at this point that she decided to see a neurologist. This film shows us the several stages of a neurological consultation, such as anamnesis, passing of cognitive tests such as MMSE, DO80, as well as an evaluation about autobiographical memory. At the end of the consultation, the neurologist suggested to Alice to perform a brain MRI to confirm or to refute hypotheses about the presence of a tumor or vascular problem such as a stroke. Nevertheless, nothing specific emerged from this examination. Thus, the neurologist proposed to perform a PET-Scan which will reveal that Alice has an episodic memory disorder with impaired brain function at frontal and temporal lobes.
After these findings, the neurologist told to Alice that she had an early onset genetic form of AD. He also pointed the consequences of this genetic disease: when the gene is present, there is a 100% chance that the disease will be developed. Moreover, this gene is transmitted from one generation to the next with a risk of 50%. Thus, Alice started to feel guilty towards her children. Her doctor also pointed out that this type of AD often progresses more quickly, especially for people with efficient and higher cognitive abilities.
The diagnosis was obvious to Alice, she knew what to expect. Little by little, she accepted the situation and found strategies to overcome her difficulties: she used her phone (reminder, diary, notes) or highlighted while she was reading to not read the same sentence twice.
Alice knew that, even if she took care to list everything she had to do during the day, until she “goes to school” and “takes the medicine”, she will eventually forget to check her list. She knew that one day it will come that she will be no longer able to recognize her husband and her children, that she will be unable to take care of herself, to dress or to eat by herself. Isn’t it terrible? A situation in which you are able to understand that you will lose everything that make you the person you have become over the years, while ignoring it when it will happen?
When Alice was still aware of her difficulties, she described her illness by saying that there are some days where she could consider herself as a normal person, and others where she couldn’t find herself anymore, by knowing who she was: a woman with a perfect speech. Now, she can only see the words but can’t reach them. A sentence has particularly marked us : “I must learn the art of losing in everyday life“. Alice was endearing and strong to face the disease that was coming down on her and that will probably kill her. She tried to overcome it, to bypass it, to consider how to leave the stage by herself before she will lose all of her abilities.
We can notice that this illness has consequences on her work: she confused classes, her students are dissatisfied, which leading to a work stoppage. It has also consequences on her social life. Indeed, her husband is moving further and further away until he leaves the conjugal home. Then, it is her youngest daughter and her home helper who will take care of her.
Critical reflexion about the movie :
This film illustrates a largely unknown form of AD. Indeed, as it is mentioned above, Alice suffers from an inherited form of AD at an early age. Sporadic AD begins around the age of 65, the hereditary or familial form of AD has the particularity to start earlier. In France, approximately 5,000 people are diagnosed with this form of AD before the age of 60 and approximately 20,000 before the age of 65 (Haute Autorité de Santé, 2018). As we have already mentioned, it has the particularity of being diagnosed in individuals under the age of 65, and sometimes even under 50. That’s what happened to Alice, the main character of the film. This particular form of the disease affects people who have had several cases of AD in their families that have been found over several generations. The symptoms are the same as those of classical AD, otherwise known as sporadic AD, the age of onset and causes of the disease remain their main difference (Wu, Rosa, Hsiung, Sadovnick, Masellis, Black, Jia & Gauthier, 2012). The early diagnosis of AD is of great interest, particularly in order to provide appropriate care and help for the patient. It allows this one and his relatives to claim a better quality of life. Indeed, the establishment of the diagnosis allows them to benefit, among others, from assistance, such as a home help who will clean the house, cooking and help the person in everyday activities such as taking a shower or getting dressed. In brief, making their daily life as easy as possible. In addition, diagnosis also helps patients and their families to better understand the disorders that can be observed during AD.
This movie is very instructive because it provides a presentation of AD from the patient’s point of view by focusing on the difficulties experienced by this one throughout the illness (forgetting, losing belongings, lack of words, sleep disorders as well as daytime sleepiness, spatial and temporal disorientation, stopping activities, confusion of people, no longer recognizing his relatives). Actually, AD is well known to the general public, people often associate this pathology with memory loss, without knowing the other disorders that are associated with it. The film provides a presentation of the various difficulties that patients may experience, while focusing on the progression of the disease. In addition, this story highlights the loss of autonomy observed in patients as the pathology progresses, while objectifying the impact that it can have on this one and his family. Indeed, we have the opportunity to note the sadness and the despair that can be felt by Alice’s relatives, as well as by Alice herself, while she was still aware of her difficulties, especially at the beginning of her illness. In addition and despite her difficulties, Alice also showed us the strength that people with AD have to face to cope with their deficiencies.
Moreover, the movie highlights different reactions that can sometimes have the relatives towards the patient’s difficulties. Indeed, some relatives can be very protective with the sick person, it’s the case for Alice’s eldest daughter, named Anna. We can notice that she overprotected Alice, she was the more attentive to her mother needs. Instead, other people can become distant from the patient. It can be explained by trying to protect themselves from the progression of the disease of their loved one. In the film, it is Alice’s husband who adopts this type of behavior. Although he was very present at the beginning of the disease, we can see that as the disease progresses, he gradually moved away, until he accepted a job offer in another city. This shows that despite all the love he had for Alice, he had the need to protect himself. These different kind of behaviors show the different reactions that can be adopted by relatives, who do not have the same strategy and abilities to cope with this dramatic situation.
In conclusion, this movie is very enriching because it presents an unknown form of AD. Moreover, although everyone has heard about AD, we are not always well informed about all the difficulties that accompanied this disease and its consequences. Then, it allows to become aware of the evolution of the disease and the impact it can have on the patient, his family and his friends. The France Alzheimer Association organizes and participates in various events to inform and raise awareness about AD, by training to support family members, professionals and volunteers who are in contact with AD patients.
Key words : Alzheimer’s disease, Early-onset Alzheimer’s disease, Autonomy loss, Early diagnosis, Close relatives.
Words we have learned :
- Fulfilling = épanouissant,
- Lack = manque,
- Relatives = proches,
- Work stoppage = arrêt de travail,
- To bypass = contourner.
Bibliography :
- Haute Autorité de Santé (2018). Parcours de soins des patients présentant un trouble du comportement neurocognitif associé à la maladie d’Alzheimer ou à une maladie apparentée : MA avant 65 ans “adulte jeune”. Retrieved from: https://www.has-sante.fr/portail/upload/docs/application/pdf/2018-05/fiche_3_ma_avant_65_ans_2018-05-24_11-36-42_498.pdf
- Wu., L., Rosa, P., Hsiung, G.Y., Sadovnick, A.D., Masellis, M., Black, S.E., Jia, J., & Gauthier, S. (2012). Early-onset familial Alzheimer’s disease (EOFAD). The Canadian Journal of neurological sciences, 39(4), 436-445.
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Lauranne Absil, Anaïs Raud, Amandine Templet, M2 PPCECC